Scabies

What is Scabies?

Scabies is a painful and itchy infection caused by a very small type of parasite, specifically a particular kind of mite. Scabies can be compared in some ways to lice, but instead of infecting the scalp and clinging to hair (lice primarily use the scalp space to lay eggs), scabies infects the skin itself. This makes for a much more resilient, much more painful illness.

Scabies is not unusual, and is quite contagious. This is augmented by its dormant period; scabies is asymptomatic for usually more than a month before anyone has any reason to suspect they are infected, which means it can spread for quite awhile before people realize the nature of the condition. Scabies is an allergic condition, brought on by the agitated response of the body’s immune system in response to a gradually increased perceived threat. This means that scabies takes a long while to present symptoms, and a longer while to heal fully, much to the dismay of those that suffer it. Because scabies is so hardy, it is sometimes called “the seven year itch”.

Who gets Scabies?

Scabies can affect literally anyone. There are no distinctions to be made about sex, ethnicity or any other detail. There is no genetic origin. As a parasitic condition, varying degrees of immune strength scarcely apply to the resistance of scabies. This said, there are certain groups that are at a certain greater risk for scabies than others for reasons unrelated to their biology.

Schoolchildren can be particularly susceptible to scabies, as they frequently don’t know better than not to scratch, which can get the mites that cause scabies trapped under the nails and allow them to be spread by touch. Skin contact is all that is required for scabies to transmit. Individuals that are likely to be in close contact with others for an extended period of time on a regular basis are similarly more likely to be susceptible to scabies infection, and are similarly more likely to spread it afterward. Additionally, groups of individuals who become infected with scabies are more likely to have difficulty getting rid of scabies afterward, as scabies can transmit and then retransmit back to the original host, even after the original host has been cured.

What causes Scabies?

Scabies is caused by the infection of small mites into the skin. Unlike some forms of parasitic infection, scabies mites penetrate the skin directly, and cause intense itching both through their movement on the top of the skin and beneath and through the skin. The only factor in scabies that can cause transmission is exposure to the mites, generally through skin-to-skin contact with another infected individual. Scratching at the itching caused by scabies can frequently trap the mites under the fingernails and place them on the fingers, where they can easily brush off if the infected individual should touch a healthy individual.

Extended skin contact for other reason can also spread scabies, as can contact of shared surfaces, shared garments and other items. Sharing towels, for instance, is a possible vector of infection, and a shared blouse is even more likely to transmit scabies from one individual to another. Scabies is occasionally mistaken for a sexually transmitted infection for this reason, as sexual intercourse can frequently result in skin contact sufficient to spread scabies. However, this skin contact is incidental to the act, and does not mean that scabies is actually a venereal disease, and it is not classified as one anymore than the flu is.

What does Scabies cause?

Scabies causes intense pruritis and inflammation, better known simply as itching. The infestation of mites that causes scabies effectively turns the skin into a small colony for the parasites, and they will proceed to crawl over and under the skin, burrowing as necessary to build their nests, lay their eggs and raise their young. Scabies feed directly on their hosts. The amount they actually feed on the cells of the host is effectively irrelevant, but their presence in the skin causes an immune response. While the mites that cause scabies can cause itching directly through their actions, the true agony associated with scabies is produced by the body’s immune response to their presence.

The skin will inflame as the body’s immune system attempts to reject the mites. This will have limited success in actually slowing them down, but it will cause an intense rash. The reaction is allergic, which is to say that it will grow more and more intense the longer it goes on. The body will react exponentially more and more violently to the infection until it is purged for whatever reason, and will frequently take quite some time to recover even after the infection is fully gotten rid of as the immune system escalates its efforts to fight off what it perceives as an exceptionally stubborn, resilient invader (which is true to a point).

The itching and inflammation caused by scabies can rapidly turn itself into a very bad rash. This rash can be quite visible (whereas scabies themselves are almost completely invisible to the naked eye, at best appearing as no more than a white or grey pinpoint n the skin). While this can signify that scabies is present, it can also result in a very intense urge to scratch. Scratching the skin while infected with scabies carries multiple consequences. The first of these is that while scratching at scabies can provide some small temporary relief from the intense itching, it can also cause scabies to spread. Scratching can tear the mites out of their nests and trap them under the fingernails, after which they can be easily deposited again elsewhere on the body, resulting in another infestation and another rash under many circumstances. This can also spread scabies to others, which depending on the nature of the infestation and the relationship of those infested can result in a prolonged case of scabies for everyone involved. The second consequence of scratching with scabies is that it can cause significant damage to the skin. This damage to the skin will not likely pose a serious health risk in and of itself, but it may still cause scarring and bleeding, which can be uncomfortable in more ways than the itch was; the scarring may be effectively permanent, as well, which makes it something to avoid even more assiduously when it can be avoided in the first place by simply refusing to scratch. The third and most serious consequence is an offshoot of the second. While the damage to the skin from the scratching itself is usually minor and can cause minor bleeding at worst, it can leave the skin with open sores. These open sores can then become infected by things much worse than scabies, particularly bacterial infections. A secondary infection to scabies can very easily be far more catastrophic simply because something nastier than scabies has moved into the open sore. To put things very simply, scratching is not worth it.

How serious is Scabies?

Scabies is a fairly serious parasitic infection simply because it is so contagious and so very easy to spread. The nature of scabies means that it can spread like wildfire through an entire classroom or office floor before anyone even begins to present symptoms. Much like lice, this can cause a panic and even significant social backlash in the right settings, especially if parents become concerned, and this concern can lead to pointed fingers and accusations being levied. The social consequences of scabies can be worse than the symptoms under some circumstances, although this thankfully requires a number of ill-tempered people in the same place at the same time, and is thus not a common result of scabies—merely a worst-case scenario.

That said, the symptoms of scabies themselves are bad enough, especially with the contagious element. The itching caused by scabies can easily disrupt one’s ability to focus on work or anything else, resulting in lost time and lost productivity. The itching can absolutely destroy one’s ability to focus, which can spell doom for children in school who are trying desperately to make the grade. It can force doctors, surgeons and other medical personnel onto sabbatical, and this is ignoring the contagious element! Scabies is nicknamed ‘the seven year itch’ in some communities because it is so resilient, and is known primarily for its itching nature.

The worst risk related to scabies is, however, the potentiality for secondary infections. The itching of scabies is bound to result in at least minor scraping and scratching and abrasion of the skin, even subconsciously, as the infected individual tries to ease their suffering. This can result in open sores and vulnerable skin, sometimes in locations that are even more vulnerable to subsequent bacterial infection. While scabies itself is irritating and distracting, even agonizing, a bacterial infection can pose a risk to life and limb.

The contagious nature of scabies can force individuals out of their workplaces and classrooms even if the symptoms are not active at the time, simply because this is the safest way to avoid contact and subsequent infection. This, coupled with the ability of scabies to spread rapidly, means that workforces and classrooms can be decimated or worse by the presence of scabies and the need for a soft quarantine as students and co-workers try not to infect each other.

Re-infection plays a role in making scabies an even worse ailment. Scabies causes an allergic reaction by the body’s immune system. This is why inflammation is such a prominent symptom, and it is why scabies grows so much worse over an extended period of time. However, the body does not develop an immunity to scabies through this reaction, nor does it develop any tolerance for scabies the way it may other virii and bacterial infections. If one is infected once with a particular virus, it is likely to be some time before they are infected again, and if they beat it once, it isn’t likely to come back unless it mutates significantly. Scabies does not follow this same principle. If one manages to clear scabies up entirely and returns to work or school or something else involving human contact only to be exposed again, they are not any less likely to be infected. This means re-infection happens frequently, and plural individuals can host plural colonies of mites that will continue to spread and go more resilient simply as a result of numbers. Unless everyone in the group receives effective treatment simultaneously, it can take months for scabies to clear on its own, if it ever does.

What does Scabies treatment look like?

Scabies treatment varies depending upon the nature of the infection in a particular individual. The first option is, of course, something to alleviate the itching. Benadryl, teatree oil and other anti-itch products are a viable option, if they penetrate deep enough to desensitize through the skin, rather than just relieving the itching of the surface.

There are a number of anti-parasitic agents available that will attack scabies directly, and all have their varying degrees of efficacy. Price is, unfortunately, a very real factor in which treatment options are used, as the most effective treatments are necessarily quite expensive due to the means of their manufacture. The most effective of these is called pemethrin, which is formulated into a cream, but it is quite expensive. Crotamiton is the next-most effective form of treatment; it is significantly more affordable, and is nontoxic. Other oral and topical treatments exist for scabies as well. All of them revolve around the simple process of killing the mites that cause scabies, but this is made somewhat difficult by their ability to burrow into the skin; if they all remained on the surface at once, they could simply be washed away with a cloth and water and forgotten about, but they are quite a bit more resilient.

Other alternative treatment methods exist as well. Soaps containing sulfur have been demonstrated to be quite effective, but these can be harsh on the skin. However, they carry the advantage of penetrating the skin quite deeply, which can root scabies out of their holes and kill them outright, preventing their spread to others and their perpetuation of the body’s immune response. Other natural agents fall in and out of vogue as well, although their effectiveness varies. Some treatments contain fat-soluble plant extracts which are thought to penetrate the skin deeply and attack scabies under the surface most directly.

Antinflammatories may be useful to reduce some of the swelling, itching and pain that can result from scabies, even in relatively small doses. Analgesics may be of use as well, depending upon the nature of the symptoms and how painful the case of scabies has actually become, although a medical professional should be consulted to see if interaction between multiple treatments is safe.

Perhaps the single most significant element of scabies treatment isn’t treatment at all, but prevention. Preventing scabies is infinitely easier than treating it, as it can generally be avoided with proper hygiene. Washing one’s hands can avoid spreading it, and bathing regularly can frequently reduce the odds of scabies getting a hold on the system. Denying scabies the contact they need to take root is the easiest way to keep scabies at bay. Proper exfoliation and skincare can cover the same purpose by eliminating scabies even as they begin to nest.

Treating scabies over the counter is a very difficult proposition. It is not a skin ailment that can be treated reliably with over the counter methods and frequently requires the intervention of a physician to properly root out and treat once and for all.

How do I know if I have Scabies?

Scabies can be identified by the location of the symptoms of scabies. There are particular locations which are more likely to be infected than others, and if the itching is taking place in one of these locations alongside a full-scale immune response, this is a likely to indicate an infection. Similar symptoms in a family member with no alternative apparent cause is also a strong potential indicator of scabies, although neither of these are significant enough to out-and-out diagnose scabies.

What is primarily used to identify scabies is the presence of burrows. Scabies burrow under the skin to survive, which is quite agonizing and itchy for their hosts. Scabies burrows follow a zig-zag pattern, but this is invisible to the naked eye. To identify them, the skin is rubbed with an ink that will fluoresce under appropriate circumstances, usually blacklight, and then cleaned. After the skin has been cleaned, it is placed under the appropriate light. If this reveals burrows, it can generally be taken as an almost sure sign of scabies being present, as there are few other ailments that can possess similar symptoms.

Even so, the true final indicator of scabies may still be looked for, and this is generally taken to be the presence of mites, eggs or fecal matter from the former, which can only be identified under a microscope due to the tiny size of the mites. Due to the difficulty of this form of identification, most dermatologists rely on the identification of the burrows for a diagnosis.

Scabies is not an ailment that can be successfully diagnosed without a medical professional. One who believes they are suffering from symptoms of scabies should contact a medical professional as soon as they are able for a consultation and analysis of their symptoms, and they should be careful in the meantime to avoid spreading whatever is causing their symptoms—an ounce of prevention being worth a pound of cure.